The minimally invasive for treatment of renal calculi in non-dilated collecting system in 210 patients
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摘要: 目的：探讨经皮肾微创治疗无积水肾结石患者的临床疗效。方法：回顾性分析2009年8月~2011年3月我院采用经皮肾镜取石术微创治疗210例无积水肾结石患者。改进人工肾积水的方法，行患侧输尿管逆行插入双J管，留置尿管，利用膀胱持续灌注通过双J逆流制造人工肾积水；超声联合X线引导下穿刺目标肾盏，建立经皮肾通道行微创经皮肾镜取石术。对手术时间、结石清除率、手术并发症等临床资料进行分析。结果：208例患者均1期穿刺成功，204例成功施行1期单通道取石，4例完全性鹿角型结石患者，因结石较大，患者年龄较大，存在基础疾病，手术时间超过2 h，改为2期手术取石；2例患者术中出血穿刺失败，中转开放手术。195例患者1期1次手术取净结石；3例患者2次经皮肾镜取石术取净结石；2例患者残留结石配合ESWL加药物排石治疗，术后1~3个月复查无结石残留，总结石清除率95.2%（200/210）。手术时间60~130 min，平均75 min。3例患者术中出血较多，输血400~600 ml。无气胸、周围脏器副损伤等严重并发症发生。结论：采用改进制造人工肾积水的方法，在超声联合X线引导下行微创经皮肾镜取石术，治疗无积水肾结石，具有穿刺成功率高、手术时间短、结石清除率高、手术并发症少等优点，是微创治疗无积水肾结石的首选方法。Abstract: Objective: To evaluate the efficacy and safety of minimally invasive percutaneous treatment of renal calculi in non-dilated collecting system.Method: A retrospective analysis from August 2009 to March 2011, Hebei University Hospital percutaneous nephrolithotomy stone surgery minimally invasive treatment of 210 cases of renal calculi in non-dilated collecting system. Improved artificial hydronephrosis way line into the ipsilateral ureter retrograde double-J tube, indwelling catheter, bladder infusion through the use of double-J counter-current manufacturing artificial hydronephrosis; Under the guidance of ultrasound combined with X-ray target calyceal puncture to establish percutaneous renal access line of minimally invasive percutaneous nephrolithotomy lithotomy. Clinical data including operation time, stone free rate, complications were analyzed retrospectively.Result: The percutaneous ranal access was successfully established in 208 patients, immediate phase Ⅰ lithotripsy was performed in 204 cases and delayed phase Ⅱ lithotripsy in 4 cases because of the larger stones, older patients, there is underlying disease, surgery for more than 2 h with complete staghorn stone type. 2 cases of patients with bleeding, so puncture failured, turn to open surgery. 195 cases of patients phase Ⅰ lithotripsy operation removed in stones in one time. 3 patients secondary percutaneous nephrolithotomy lithotomy removed in stones; 2 patients with residual stones ESWL plus drugs row of stone treatment, after 1 to 3 months later without residual stones, the total stone-free rate amounted to 95.2%. Operative time ranged from 60 to 130 minutes, an average time was 75 minutes, 3 patients were surpported by blood transfusion, severe complication did not occur during nephrolithotripsy.Conclusion: A modified method of manufacturing artificial hydronephrosis in the B-joint X-ray guided minimally invasive percutaneous nephrolithotomy stone surgery, treatment of kidney stones without water, with a puncture success rate, shorter operative time, stone-free rate, surgery fewer complications, a minimally invasive treatment of kidney stones without water the preferred method.
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